Provider Demographics
NPI:1588976989
Name:WELLINGTON, DEBRA P (SCHAS-452)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:P
Last Name:WELLINGTON
Suffix:
Gender:F
Credentials:SCHAS-452
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:376 W PALMETTO ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-4418
Mailing Address - Country:US
Mailing Address - Phone:843-662-7181
Mailing Address - Fax:843-662-7181
Practice Address - Street 1:158 S CASHUA DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-4080
Practice Address - Country:US
Practice Address - Phone:843-662-7181
Practice Address - Fax:843-662-7181
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-14
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCHAS-0456237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist